Doctor Empathy

Can listening to their own interactions with patients help doctors be more responsive to patients' concerns?

Empathy is a big part of what patients consider a doctor's bedside manner. The simplest definition of empathy is understanding what another person is feeling. A broader definition includes the ability to share in those feelings. For doctors, understanding their patients' cares and concerns can make a huge difference in patient satisfaction. This is especially important when those doctors are oncologists treating cancer patients confronting a life-threatening disease.

It's not that the doctors are uncaring, it's that they need to learn how to communicate their cares better.

The goal of empathic training is to have doctors respond more appropriately and helpfully to patient fears and concerns. Courses can cost in the thousands of dollars. Now one doctor has designed a CD tutorial that streamlines the teaching process to about an hour and costs only $100. A study testing its effectiveness found that it greatly improved the way oncologists responded to their patients' fears and concerns.

Previous studies indicated that oncologists respond to patient distress with empathy only about a quarter of the time. A 2008 study of lung cancer patients found that their doctors responded empathically only about 10% of the time when such responses would have been appropriate.

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Here's an example from the 2008 study, where a patient discusses the role of smoking in the development of his lung cancer:

Patient: No, sir, I've never had a heart attack, Supposedly, I worked very hard when I was a young man, a young boy. I was doing a man's labor and I was always told I had a good strong heart and lungs. But the lungs couldn't withstand all that cigarettes . . .

Doctor: Yeah.

James A. Tulsky, director of the Duke Center for Palliative Care thinks doctors can do better. Dr. Tulsky has seen that when cancer patients bring up their worries, doctors often change the subject or focus on the medical treatment rather than the patients' emotional concerns. He also notes that responding empathically is a skill set that's often foreign to doctors. It's not that the doctors are uncaring, it's that they need to learn how to communicate their cares better.

So Dr. Tulsky and his colleagues designed a computer tutorial to teach doctors how to do so and then put it to the test.

The team enrolled 48 oncologists and 264 cancer patients in a study that began by making an audio recording of between four and eight visits of each patient with their doctor.

All the doctors then attended an hour-long lecture on communication skills. Half were randomly assigned to also receive the CD-ROM tutorial, the other half were not.

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The tutorial taught the doctors basic communication skills, including how to recognize and respond to patients expressing a negative emotion and how to share information about their prognosis. Because it was an interactive tutorial, it was able to do more. The CD allowed the doctors to hear examples from their own patient encounters and offered feedback on how they could improve them. It asked them to commit to improving their communication and reminded them of this commitment before their next patient visits.

Afterward, doctor-patient visits were again recorded and were assessed by both patients and trained listeners, who evaluated the conversations for how well the doctors responded to their patients.

Oncologists who hadn't taken the tutorial made no improvement in the way they responded to patients when confronted with concerns or fears. Those who had taken it responded empathically twice as often as the other doctors. They also were better at eliciting patient concerns, using tactics that promoted these conversations instead of ones that shut them down.

Perhaps most importantly, patient trust in these doctors increased significantly.

Although the tutorial is not yet widely available, efforts are underway to make it so.